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Dry Eye Syndrome
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(click image for
larger view)
This surface of this eye is dry
as noted by the dull shine. The
pink color is a painless dye stain
applied during an eye exam to show
the dry spots on the cornea.
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Dry eye syndrome is one of the most common
conditions diagnosed by eye care professionals. While there
are various mechanisms producing dry eye syndrome, the basic
premise rests upon the fact that there is not an adequate
tear film on the surface of the eye. Sometimes this is caused
by increased evaporation of tears, and other times this
is caused by decreased tear production (a common consequence
of aging). In addition, dry eyes may be caused by poor composition
of tear film. The tear film is made up of three layers:
lipid oils from the meibomian glands in the eyelid, mucous
from the conjunctiva, and water from the lacrimal gland.
Abnormalities of any of these layers may produce dry eye
symptoms. These symptoms include a foreign body sensation,
irritated eyes, red eyes, blurred vision, a scratchy and burning
sensation of the eyes, fluctuating blurred vision, and excess tearing.
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(click image for
larger view)
Tears are made up of layers: water,
oil, and mucus. If any one of the
three are abnormal, then symptoms
may arise.
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One way to understand the treatment of
dry eye syndrome is to compare the eye's tear production
and drainage to a sink. The lacrimal gland is the faucet
of the sink. Each eye has one puncta in each of the two
eyelids that drains the tears from the eye into the nose
much the same as a drain removes fluid from the sink. If
your goal was to accumulate fluid in the sink, you would
either increase fluid into the sink from the faucet, or
try to prevent fluid from being removed through the drain.
In dry eye syndrome, these two goals can be accomplished
by adding artificial tears or placing punctal plugs into
the eyelids. Supplemental lubrication in the form of artificial
tears and ointments is the first line of therapy. These
can be instilled as frequently as needed, even hourly in
severe forms of dry eye. The non-preserved form of artificial
tears are preferred when tears are applied more than 6 times
daily. In addition, consideration is given to punctal plugs
when eyes are severely dry. Punctal plugs are small silicone
plugs that can be easily placed into the puncta and limit outflow of tears into the nose. This procedure is reversible and is performed in the office under topical anesthesia.
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